Grant: Catalyst Grant: Health Services and Economics Research in Cancer Control

Drug costs represent a rapidly growing expense for public health care systems. In cancer care, the emergence of new treatments has become a regular occurrence and easily outpaces budget growth. As a result, provincial funders must use evidence to prioritize and fund select drugs from the 'pipeline' of new drugs awaiting funding. Our team believes that the prioritization process should not only consider the evidence for the drugs in the pipeline when allocating resources, but also for the drugs that are already being funded. The objective of this study is to enable Canadian cancer agencies to optimally distribute their drug budgets by providing them with real world evidence (RWE). Decisions to fund these drugs would have been made based on controlled clinical trials, where the population or environment may not reflect clinical practice in the "real world." RWE harnesses population-level data to capture all patients in a given jurisdiction, creating a more accurate picture of clinical benefit and cost-effectiveness, which is particularly important if patients are not benefiting to the extent that was originally expected. For this study, we will be evaluating melanoma treatments in Ontario, British Columbia and Saskatchewan. The overarching hypothesis of this work is that population-level safety, survival, and cost-effectiveness of cancer drugs will differ from early projections that informed current practice. If our hypothesis is correct, the results of this work will be used not only to support evidence-based policy reform, price renegotiations, and reallocation of funding from low- to high-value settings, but will also drive accountability and sustainability of the cancer system in an innovative way that can be replicated by other provinces and areas of the health care system.